Azygous location of port | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Azygous location of port

Frontal view of the chest without (image 1) and with (image 2) annotation shows an abnormal course of the left internal jugular port. The distal portion of the port is directed medially and resides within the azygos vein. Normally, the tip of a neck or upper extremity venous catheter should reside within the superior vena cava. Larger catheters may terminate within the right atrium. The azygos vein location is not considered central and, in most cases, should be repositioned.

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Image: Digital subtraction venogram demonstrating collateral flow from the left upper extremity. The accessory hemiazygos vein (white arrow) has become a prominent collateral of the left subclavian. Flow is reversed within the left bronchial veins (black arrow), seen receiving blood from the accessory hemiazygos vein and/or left superior intercostal vein. As a result, the left bronchial venous plexus is filled with contrast (yellow-dashed arrow). This plexus drains to the pulmonary veins. This case highlights the life-threatening complications that may result from neglect of an implantable central venous catheter. Preventative measures are to promptly recognize and treat catheter-related thrombosis and to remove unneeded catheters.

AP abdominal radiograph in a newborn status post umbilical venous catheter (UVC) placement shows branching linear lucencies overlying the liver & extending peripherally (white), typical of portal venous gas. While portal venous gas may accompany pneumatosis in the setting of necrotizing enterocolitis, it may also result from umbilical vein catheterization (the culprit in this case based on prior & follow-up imaging & clinical history). The UVC (blue) is malpositioned at the superior mesenteric vein (SMV) & should be repositioned to prevent hepatic infusion & SMV thrombosis. #TummyTuesday

Chest radiograph following replacement of the left upper extremity PICC with a right upper extremity PICC shows the tip of the catheter (arrow) in the right atrium. On the previous image, the catheter remained to the left of the midline and left of the right mainstem bronchus consistent with an arterial location within the aorta. After replacement, the catheter tip is in the venous system. However, it remains in an abnormal location. The expected location of the PICC is in the superior vena cava. On radiograph, this tip should be within two vertebral segments of the carina. #FridayQuizDay

56 Y/O female with chemotherapy port L Suvclavian vein 2 yrs ago. Now unable to flush, CXR fractured port symbolized to RV. port retrieved with Cook 20 mm snare.

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